Medical Marijuana for Migraine

Despite immense curiosity among people with migraine, most information on using medical marijuana for acute or preventive migraine treatment is anecdotal. Here are some frequently asked questions about marijuana for migraine with answers based on current medical understanding.

Does marijuana work for migraine?

Researching medical marijuana is difficult legally, so there have been no high-quality blinded studies on its use for migraine. Almost everything you hear about marijuana’s use for migraine is anecdotal or comes from a small number of rat studies. Given the multiple ways marijuana and cannabinoinds, chemical compounds found in marijuana could work for migraine, researchers believe a potential benefit is plausible.1,2 The multiple headache specialists I have discussed this with have said that about half their patients get migraine relief from marijuana and the other half say it makes their attacks worse. This is what anecdotes from patients I’ve spoken with also indicate. Marijuana is widely regarded as a treatment for nausea (some synthetic cannabinoids have received FDA approval for this purpose)3, which could provide symptomatic migraine relief.

What kind of marijuana is best for migraine?

Sativa and indica are the two species of marijuana most widely available. Within these species (or a hybrid of the two), there are hundreds, if not thousands, of different strains. Strains are cultivated to have different effects (for recreational marijuana, this could be a “body high,” “head high” or high THC content) and treat different symptoms. Despite marijuana being sold only as medicine in 21 U.S. states, most current strains were developed to deliver the biggest high.4

If you tried marijuana for migraine and it was ineffective, the problem may have been the strain you tried (or it could simply not be effective for you). Dispensary employees should be able to talk you through the different strains they carry and which are most likely to be useful for your symptoms, though the knowledge of employees varies widely from one dispensary to the next. You can also look up strains on the website Leafly, which catalogs the positive and negative effects on each strain based on user feedback (like Yelp for marijuana). To find specific strains, you can search by condition or symptom, including migraine, headache, nausea, insomnia and anxiety. Not every strain will be available at every dispensary and even the same strain can have variations depending on the growing conditions of that particular crop.

What is the dosing for marijuana to treat migraine?

There are no guidelines for marijuana use for migraine, but caution is recommended. As with pretty much all medications, the goal is to find the lowest effective dose. Given that, for acute treatment, it’s best to start with a very small amount and watch your symptoms carefully to see if they improve, worsen or remain the same. Then you can use more if you decide it is necessary. Depending on how much you use, there’s a chance you’re not treating the migraine, but are getting so high you don’t notice it. Only you can decide if that’s a wise long-term strategy for you. Some people report using marijuana as a migraine preventive, though typical dosage seems to vary widely. Jessica Catalano, who has recently published a medical marijuana cookbook, reports using 25 to 40 mg of an edible nightly as a migraine preventive.5

Can marijuana cause rebound (medication overuse) headache?

Again, this hasn’t been studied. When it comes up at conferences, physicians say they’ve seen patients with rebound headaches from marijuana and they treat it the same way as opioids. Opioids should not be taken more than 10 times a month. It’s recommended to follow that guideline for marijuana and to use as little as possible each time.

What’s the best way to take medical marijuana?

Much like oral triptans vs. injected triptans, the delivery method you use for marijuana can influence its efficacy. Smoking gets the marijuana into your system quickly and it won’t take long before you can assess whether you need more. There are risks with smoking anything, though a large, 20-year study on lung function and smoking found marijuana to be less damaging that tobacco.6 (Vaporizers also get the drug in your system quickly and may be less harmful to lungs than smoking.7).

Eating marijuana delays how quickly it takes effect. Delayed stomach emptying, a migraine symptom, could mean you don’t absorb as much of the drug as you need. If you vomit during your migraine attacks, you may not get much of the drug in your system at all. (A friend who used Marinol for chemo nausea told me the effects varied dramatically. Sometimes it was really helpful, other times not at all. She said the efficacy seemed to depend on how long it had been since she’d eaten and how efficient her digestive tract was that day.)

What other questions do you have?
These are the top questions on marijuana and migraine, but you very likely have more. Please leave them in the comments and I’ll do my best to answer them in a future post.

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Comments

Please if anyone knows how to obtain medical use in North Carolina I would greatly appreciate it. Having tried several strain’s found the Indica and Sativa to be very effective with minimal small doses throughout every day reduced length and intensity of Chronic Migraine. Putting this out there because NOTHING else has worked for me. Tried facial decompression in brow surgery and its a NIGHTMARE DON’T HAVE IT. Well for me anyway. Imitrex injections offer mild relief and Botox offer mild relief with less intensity but only lasts a week after treatment’s. Ok hope my input helps surely something will come our way.
God bless everyone suffering still.

I tried medical marijuana leaf and shake tea. Didn’t really feel much the first few days of trying it. Then one day about a week later it really hit me hard. Never went to the ER for migraine but ended up there for a bad reaction to the “tea”. My body went numb and it felt like my breathing tube was closing up and I was passing out. The doctor said that with ingestibles it is very easy to get too much and different people have a different tolerance level. So if anyone tries it be sure to get really good guidance by people who really know their product. Some dispensaries know a lot and others just sell it.

My doctor has spoken to me about maybe trying Marinol as he has good reception from a few other patients. I am not sure where I am at with it. I feel like still in the reference-gathering stage. I have been daily chronic for five years, migraineur for forty years total. Totally disabled and ready to try plenty of “tricks.”

I am one of those poor souls it does not work for. It isn’t legal where I live, although i believe it should be, I have many friends that are smokers. I tried it “for fun” several times many years ago and turned into a paranoid freak. Thought I would try again as a 41 yr old woman and some super high quality product. still slightly paranoid but more importantly my headache became SO much worse. I was about to have someone take me to ER when I figured out if I lied totally still it was bearable. it doesn’t work for me, but it does for so many I would say it is worth a shot to try, not sativa, you don’t need a body buzz but some mostly indica, just my opinion from friends with migraines that say it’s their saving grace

I am so grateful for this discussion and the fine moderator!
It seems to me that with so many gnes involved in migraine…it would not be a surprise if some people responded to different cannabinoids.
I read that there are so many different compounds in MJ that each strain is different ..not just indica vs sativa… Even a single strain might grow differently during different seasons or in different parts of the country.
I have read that there is a synergy of the THC (like dronabinol) with CBD’s that is medicinal. Something about the balance in the plant as a whole that contributes to it being effective.
Finding the right balance might change with season or altitude or who knows?
A more subtle approach might allow Migaineurs to be flexible and contribute to the knowledge base by keeping diaries. Where it is legal of course.
Anecdotes are not research but maybe it would help.

Thank you so much for this article & all the very informative info fellow migrainers have posted. I’ve been wondering about medical marijuana use for migraines for awhile now, & will definitely research it since my state allows for medical usage.

I’ve wanted to try medical marijuana and it’s legal in my state, but the medical marijuana card is so expensive ($200/year) that I haven’t gotten one. But considering that I spent $800 out-of-pocket on Botox for migraine and that didn’t help, maybe I will just have to bite the bullet and get that card. (I’m 45 and get about a dozen migraines a month.)

I’ve never tried marijuana medically or otherwise, but I have found just being around it makes my migraines far, far worse. The smell seems to be a trigger for my migraines, worsening them until I cannot see or hold down food.
So I’m thinking this isn’t the route for me… which is too bad as so many people seem to have success with it.

Some of my friends who can’t stand the smell (whether it’s a migraine trigger or simply an annoyance) have had a lot of chronic pain relief from eating it. This is in California where they buy lollipops they can nurse over several days. It might be worth looking into if/when medical marijuana is legalized in more places!

I am not a doctor, I don’t have any medical advice and here is my experience with (MMJ).

I live in a state where Medical Marijuana (MMJ) is legal. My PCP (primary care physician) is against it but since I am unable to find relief, I went to another doctor and filed my paperwork. I researched it, went to different dispensaries and asked many questions specifically for migraine disease and the symptoms I have.

This is how it was explained to me. Indica – in the couch. It is very relaxing, depending on the THC levels would depend on the “head high.”

Sativa is more of a “happy high.” If you have things to do, places to go, this would better fit but NEVER DRIVE HIGH.

Indica was suppose to be good for nausea, anxiety, pain relief and insomnia. All of which I had scripts for, daily. I slowly backed off my scripts and tried different doses of edibles, oil drops, mints, etc. I wasn’t as interested in smoking but when nausea turns to vomiting, smoking becomes the only option. So I tried a few different strains of Indica, ranging from 18 to 24%.

Prior to trying my own experiment, I had 21 to 23 migraines days a month, sometimes more. The Meds I used took the edge off but never stopped the pain. The other days my head was in a fog from the Meds, migraines or both. *big sigh*

I kept a journal and began. I noticed a difference immediately. Especially if I took my abortive Meds and a small amount of edibles. I would fall asleep and walk up pain free.

I don’t get any warnings, no aura, just BAM the ice pick in my eye. So, being able to get a reduced pain and no pain was a joyous occasion for me.

Unfortunately, I was unable to continue my experiment because my PCP also drug tests me.

The CBD oil although does not give you a “head high” because it doesn’t have the THC content required for the “head high” will still cause a “hot” test. THC will show up in your drug screen.

THC is fat soluble and stored in the fat cells of the body. If using edibles, it is better absorbed if taken with fatty food.

Depending on your BMI (body mass index) will depend on how long it stays in your body.

I have a tool within reach that I can’t use. It is very frustrating and more testing needs to be done.

I know what you are thinking and yes, I am considering it too…find another doctor that is willing to try whatever it takes to help me and get over the stigma of MMJ.

Thank you for this well-explained and extensive feedback–I imagine that I am not the only one who was tempted to take notes on what you wrote here. I’ll have to refer back to this article if my state ever legalizes medical marijuana!

Take care, and good luck finding that new primary care doctor (smile).

HereWeGoAgain
Hi Kerrie, I have only recently learned (here on Migraine.com) about marijuana being available in all these forms, other than something you have to smoke. I would love to try these vaporizer or oil or caramel options if only they were legal!! What, if anything, can we do as a group to encourage research and legalization of medicinal marijuana in our individual states?

A good place to start might be with a letter to your local and state lawmakers explaining a little about your background and how medical marijuana is a safe and potentially effective treatment for your illness.

Thank you so much for writing this. Medical marijauna has proven more helpful than most of the RX recipes I have endured over the years. I Have chronic daily Migraine with aura for what seems like forever. I still benefit from some pharmaceuticals- gabapentin and Horizant for “restless legs” but have had little benefit from the world tour of RX.
I find medicinal tea made from high CBD strains to be most helpful. Thanks for reminding me about gastric emtying being a symtom. Tea seems to have calmed and restored my intestinal process. Vaporizer is great before bed if it is one of “those” nights when it seems leep will never come.(immediate) I am reluctant to smoke much. . CBD caramel that is absorbed slowly ( letting the candy melt in the mouth) is a Real treat (intermediate). And sublingual oils. Each method allows different rate and level of absorption.
It is a challenge when some of the symptoms of Migraine syndrome make me appear intoxicated to others. Even the way I have to manage thoughts and feelings is altered by migraine…so sometimes it is hard to know if I am “too stoned to notice the difference” between Migraine blurr and side effects- but I do know. If I am able to tune in to pleasure of any sort instead of “disappearing”, it is surely a good thing.
I limit my use more than I should. My partner is a great mirror and remarks on the apparent reduced pain & release from the inner tightening/anxiety (which often shows up in one phase or another of chronic daily Migraine) and often asks if it would not be a good idea to smoke “a little” to see if I get relief. Most often just a little is what I need to return to deep and relaxed breathing and some ease.
Thanks for the reference about strains. My dispensary doesn’t have CBD oil but is very helpful in making recommendations as the supply changes. I saw someone selling CBD oil made from hemp. This is legal They say).

Hope you can post more about the research and potential of canabinoids and how they are involved in pain management. I know there is little human trial stuff but the neurobiology and current thinking would be terrific to learn about.

You said a lot of smart things here, but this hit home the most for me: “My partner is a great mirror and remarks on the apparent reduced pain & release from the inner tightening/anxiety (which often shows up in one phase or another of chronic daily Migraine) and often asks if it would not be a good idea to smoke ‘a little’ to see if I get relief.”

I have a hard time keeping track of how I feel (right down to muscle tension, irritability, etc.) and my boyfriend is often a great person to hear from on this front. He’ll say something like, “Do you need to take a break from work?” I’ll ask him why, and it’s because he’s noticed in my posture or in the sheen of my eye that I may be starting to feel sick.

And as far as your last point goes: rest assured Kerrie and the rest of us here on the Migraine.com team will share more information about research on MMJ for migraine as it emerges.

There is such a need to address and discuss this! So much so that I have now created an account. I’m very happy to have read this article. I’m not sure when my migraines started, as they seemed to slowly increase in intensity over time, and I can recall often feeling unwell and headachy as a child. However, medical marijuana has been helping me cope, and improving my daily quality of life, for years.

My experience has been very similar to Violet’s – strains that are mostly Indica are MUCH more helpful (such as a strain called Corleone). Some strains are much less helpful, or even make it worse. I too have noticed that a few puffs at the right time of day (for me, it’s about half an hour after I wake up) can make a HUGE difference in terms of frequency and intensity of my migraines. While I also find it very helpful for managing pain and nausea during attacks, it seems best not to wait.

To anyone who is considering trying (or re-trying) medical marijuana, I’d recommend keeping in mind that often someone’s first experience, or two, with marijuana are drastically different than the third, fourth, and so on. It’s also best to pair it with a relaxing activity in a pretty low-energy environment, like a quiet movie, yoga, or some quality time on the couch with your pet.

Marijuana has changed a LOT over the years, as have the quality and variety of delivery methods. There are many options available to you that are worth looking into if you are considering medical marijuana.

Tried smoking 40 years ago to see what would happen. Headache got MUCH worse! At the time I did not have any meds that worked either. Never tried it again. But it’s good to know that it can help some people. Mine aren’t as frequent now that I’m older nor as bad.

Thanks for your comment! If you are in a state where medical marijuana is legal and you’re ever interested in trying again, I’d look at Kerrie’s advice (as well as the comments from readers) and talk to the dispensary about what strain might work best for you. Until recently I had no idea there were so many types with so many effects! Some of my migraineur friends can’t tolerate some strains due to worsened migraine symptoms, but other strains help them immensely. It surely is complicated.

I’m glad to hear that your migraines aren’t as severe or frequent as they used to be. I hope you’re feeling well today.

I am a 10-13 days migraineur. I did a little test trial with myself, started one year ago. Tried it all: high CBD oils (serveral strains), edibles, vaporizing. I ended up with simply two puffs vaporizing at night as a preventative and it works amazingly good. In fact, it works better than any betablocker or other preventative ever did. Intensity is still going down every month, full blown migraines have become rare, instead I get these mini migraines that don’t make me bedridden. Frequency is down to six (mild) days at the moment. Triptan use is down to 2 per month.

I found, that for me ONLY those strains work that have as much Indica as possible. That means for me, I need a ratio of Indica to Sativa of minimum 80% Indica. Too much Sativa often has the effect that it causes migraine after a couple of days. A Sativa induced migraine can be cured fast with a couple of puffs Indica. Infos for the ratio of strains can be found for example at wikileaf.com.

I still like the idea of CBD oil, but most, if not all of the high CBD strains have too much Sativa. Unfortunately, I didn’t find any with a 80/20 ratio.

For the record: I am 51 and I have never used/smoked Marijuana in my life. I started it as a last resort (and I could because it is legal here where I live), when my preventative Propranolol caused an anti-immune reaction and I had to stop it. I am glad I did. The side effects of Marihuana are far less (to none) compared to any side effects I had with other preventatives (anxiety, hair loss etc). It was hard for me to make the decision and go to a doctor and I still feel strange because Marihuana is stigmatized. But I have to say that Marijuana is the best that ever happened to me in my whole migraine life.

Thank you for your specific and very helpful feedback! I think many people who’ve never tried marijuana feel like it’s not an option for them because they’re too old, or because they never tried it, or because it’s too “out there.” Your story helps remind us all newly approved treatments, once deemed safe and legal, can help.

Thanks again for this–I don’t know many people who have such meticulous records of what does and doesn’t work for them, MMJ-wise.

Thanks for writing about this. A discussion is long overdue. I have chronic daily headache and marijuana has been a great help. I use an indica strain via vaporizer fairly regularly to help with sleep, which in tern helps reduce frequency of my headaches. I use a saliva strain (right now) 2 or 3 times a month during the worst headaches to reduce nausea and allow me to sleep through the worst of it. It does not make my headaches worse or more frequent. I continue to use preventative and abortive migraine medication.